title: Premenopausal hormone-responsive breast cancer with extensive axillary nodes involvement: total estrogen blockade and chemotherapy.
abstract: BACKGROUND
  Poor prognosis is associated with estrogen- and/or progesterone receptor-positive (ER(+), PGR(+)) premenopausal breast cancer (PM-BC) with high Ki-67 labeling index and extensive axillary lymph node involvement. The role of adjuvant chemotherapy (CT) and hormonal therapy have not yet been established in these patients.
  
  
  METHODS
  Twenty-five PM-BC patients received, in sequence, leuprorelin, taxane-anthracycline induction chemotherapy, radiation therapy, a platinum-based intensification high-dose CT, followed by leuprorelin and anastrazole for five years. Vascular endothelial growth factor (VEGF) levels were measured as the primary end-point; secondary end-points were 10-year relapse-free survival (RFS) and overall survival (OS) rates.
  
  
  RESULTS
  The median patient age was 44 years, and the mean number of positive axillary nodes was 14. All patients were ER(+) and/or PGR(+), with a median Ki-67 index of 33%. Five patients were Cerb-B2 positive. Grade 4 hematologic toxicity was observed in all patients, no patient showed a decrease of cardiac ejection fraction and hot flashes and arthralgias were of moderate intensity. After a median follow-up of 70 months, VEGF levels significantly decreased (p<0.001); 10-year RFS and OS were 76% and 78%, respectively.
  
  
  CONCLUSIONS
  Total estrogen blockade and high-dose CT in PM-BC patients is feasible, has moderate toxicity, significantly reduces VEGF levels, and seems to improve the expected RFS and OS.
authors.affiliation: Civilian Hospital, Oncology Department, Avezzano, Italy. frecchia1946@libero.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Recchia
authors.forename: Giampiero
authors.initials: G
authors.lastname: Candeloro
authors.forename: Stefano
authors.initials: S
authors.lastname: Necozione
authors.forename: Giovambattista
authors.initials: G
authors.lastname: Desideri
authors.forename: Cornelia Ortensia Carla
authors.initials: CO
authors.lastname: Recchia
authors.forename: Juan
authors.initials: J
authors.lastname: Piazze
authors.forename: Silvio
authors.initials: S
authors.lastname: Rea
mesh_terms: D000328:Adult; D000077384:Anastrozole; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000009:adverse effects; D001943:Breast Neoplasms / Q000097:blood / Q000473:pathology / Q000628:therapy*; D016190:Carboplatin / Q000008:administration & dosage / Q000009:adverse effects; D003131:Combined Modality Therapy; D000077143:Docetaxel; D015251:Epirubicin / Q000008:administration & dosage / Q000009:adverse effects; D004964:Estriol / Q000097:blood; D004965:Estrogen Antagonists / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D007069:Ifosfamide / Q000008:administration & dosage / Q000009:adverse effects; D016729:Leuprolide / Q000008:administration & dosage / Q000009:adverse effects; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009376:Neoplasms, Hormone-Dependent / Q000097:blood / Q000473:pathology / Q000628:therapy*; D009570:Nitriles / Q000008:administration & dosage / Q000009:adverse effects; D017697:Premenopause; D011960:Receptors, Estrogen / Q000096:biosynthesis; D011980:Receptors, Progesterone / Q000096:biosynthesis; D043823:Taxoids / Q000008:administration & dosage / Q000009:adverse effects; D014230:Triazoles / Q000008:administration & dosage / Q000009:adverse effects; D053380:Tumor Necrosis Factor Ligand Superfamily Member 15 / Q000097:blood
chemical_list: D004965:Estrogen Antagonists; D009570:Nitriles; D011960:Receptors, Estrogen; D011980:Receptors, Progesterone; C117026:TNFSF15 protein, human; D043823:Taxoids; D014230:Triazoles; D053380:Tumor Necrosis Factor Ligand Superfamily Member 15; D000077143:Docetaxel; D000077384:Anastrozole; D015251:Epirubicin; D016190:Carboplatin; D016729:Leuprolide; D004964:Estriol; D007069:Ifosfamide